Thursday, February 6, 2014

Expert Q&A: Heart Health

Last year brought about a lot of changes in how we think about heart health. We heard about new guidelines on cholesterol and blood pressure. We heard more about the dangers of salt and sugar to our hearts.

With so much attention focused on heart health this month, we thought it would be a perfect time to get more insight into these and other changes. To do that, WebMD writer Kathleen Doheny talked to Mariell Jessup, MD, president of the American Heart Association. Here’s what Jessup, a professor of medicine at the University of Pennsylvania Perelman School of Medicine, had to say.

Last year, the American Heart Association and the American College of Cardiology changed the guidelines about cholesterol and who should take the cholesterol-lowering drugs known as statins. Can you explain what the changes are and why they were made?

The new guidelines take the emphasis away from focusing only on a specific number for so-called ”bad” cholesterol, or LDL, and focus instead on the patient’s risks. “Previously, doctors were told they had to have their patient’s LDL cholesterol lowered to a certain value, depending on risks. If a patient had had a heart attack, the LDL should be below 70. If they had a risk score that predicted a higher risk of cardiovascular disease in a 10-year period, their LDL should be under 100. For others, under 130.”

The new guidelines advise not treating a lab test number. Instead, they evaluate a person’s risk of having a heart attack or stroke and then suggesting statins, if appropriate.

For instance, a patient who has had a heart attack should be on high-intensity statins. Others may not need a statin but may need to lose weight or make other lifestyle changes.

Some doctors have challenged these new guidelines. Why? And will the AHA and the ACC continue to evaluate the guidelines?

“They are challenging them because it’s a big change. Change is hard, even if it’s change for the good. Many clinicians feel strongly that the lower the LDL is, the better it is for the patient. Unfortunately, there are not a lot of randomized controlled trials [the ''gold standard''] that support that view right now.”

New data is constantly being reviewed and added into the guidelines when needed. “We are just saying, ‘This is what the facts are now.’”

If someone who was not on statins under the previous guidelines now is prescribed them due to their risk or history of heart attack, can they try lifestyle measures first?

Yes. “The prevention guidelines are a tool to begin a conversation between providers and their patients. The first task is to assess risk, then consider lifestyle therapy in everyone. For patients at higher risk, [doctors would] consider adding a statin. Of course, lifestyle changes are critically important. Indeed, that is why we published a separate guideline on lifestyle.”

The lifestyle guidelines cover diet, exercise and other measures.

Q: Although people can often improve their heart health through lifestyle changes, many have a difficult time doing so. Why is that?

When it comes to a healthy lifestyle, our culture is far from encouraging. “Many Americans don’t have access to fresh fruits and vegetables, or a safe place to exercise. The availability of unhealthy foods like sugar sweetened beverages or salty snacks is ubiquitous. This needs to change. Lifestyle is a potent weapon against cardiovascular risk, and we need to make it easier for people to harness that power.”

If you were telling someone to adopt just one new, healthy habit, what would it be?

“Get regular exercise: walking instead of riding, taking the steps instead of the elevator. Just aim for at least 30 minutes of walking [daily] for the sake of walking–not as part of your job.”

More research is coming out about how bad sugar can be for your health. Do you think excess sugar will be seen as bad as excess salt?

“No question about it. There is almost no nutritional value to this refined sugar glut that so many Americans are accustomed to. I think everyone agrees it contributes to excess obesity, to excess diabetes. There was just a paper that shows it actually contributes to cardiovascular death.”

Women should aim to eat less than 100 calories a day (6 teaspoons) from added sugars, she says. Men, under 150 calories (9 teaspoons).

Recently, an expert panel also issued new guidelines about blood pressure. What do these new guidelines say and why?

The panel reviewed the evidence on blood pressure control for heart health. It suggested that ”the optimal targets for blood pressure be changed from the previous panel’s recommendation.”

For those age 60 and above, for instance, medication is advised if the pressure exceeds 150/90 instead of 140/90, under the new guidelines.

”They also suggest that every encounter with a physician should begin with a discussion about lifestyle–such as sodium intake, alcohol, weight and exercise.”

Doctors caring for patients with high blood pressure should also take into account the other medications a person is on, especially older persons, under the guidelines. “The older a patient gets, the potential adverse effects of drugs become more important. Clinicians have to take into consideration the age of the patient and their target [blood pressure] and the drugs they use to control the pressure.”

The emphasis on blood pressure control for reducing the risk of heart attack and stroke remains the same.

We hear a lot of talk about so-called ”super foods” for heart health. What are your favorite go-to foods for heart health?

“Plenty of fresh fruits and vegetables, and several servings of fish each week.”

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